More than 7.5 million people have signed up for new health coverage through the Affordable Care Act's state and federal health insurance marketplaces at the close of the first enrollment period.
The Department of Health and Human Services reports that another 3 million people have gained health coverage through Medicaid or the Children's Health Insurance Program (CHIP) as of the end of February, compared to figures five months earlier.
Now we're about to find out something critically important: whether having health coverage translates into receiving health care.
Let's be blunt: one of the biggest problems with America's health care system is that it neglects the poorest among us. People of color suffer more and die earlier than others. The U.S. continues to have one of the highest infant mortality rates among the 14 wealthiest countries, and it's higher in communities of color.
The reasons for this disproportionate suffering and dying in communities of color are rooted in economic inequality and segregation -- with their associated poor housing, poor nutrition, poor schools and toxic environments.
In his recently released budget, President Obama calls on Congress to find the money to train more health care workers, including doctors, to work in these significantly underserved communities. The budget appropriates $14.6 billion to expand health care and medical training programs. This investment in our health workforce to meet the health care needs of neglected communities is desperately needed.
Whatever your opinion is about the Affordable Care Act, its strength is a series of features designed to get at this deficiency in our moral landscape. Some of the most chronic health problems in our country could be countered just by having access to medical professionals dedicated to disease prevention. But having insurance doesn't guarantee having access, especially in poor communities.
New York, for example, rightfully takes pride in having a high number of physicians serving the health care needs of its population. The ratio of primary care physicians in Manhattan is 145.6 per 100,000 patients. But the ratio drops dramatically to 68.7 in the Bronx and 65.6 in Queens.
For entirely practical reasons, health care providers locate their practices where there are paying customers nearby. What will happen when the implementation of the ACA brings in millions of newly insured patients? Suddenly, previously under-served communities will have insurance. But will those new customers be able to find a doctor?
The President's budget proposal funds training for doctors and clinicians in the most under-served communities. It includes:
• $5.23 billion over 10 years for a program to support training 13,000 physicians who would be assigned to serve in high-need areas.
• $3.95 billion over six years to expand the National Health Service Corps to 15,000 providers, up from the present 8,900.
• $5.44 billion to extend increased payments to encourage primary care providers to serve or keep treating Medicaid patients.
The additional funding will also create good-paying jobs in communities that desperately need them. Health care practitioners and related technical occupations are overwhelmingly good jobs - 95 percent of the jobs in this sector nationwide pay median wages above $15 an hour.
Clearly, building the health care workforce for these previously under-served communities is absolutely critical. The president's proposal is a strong step toward attacking this problem. So how do we expect Congress to respond?
Here are some hints: First, the proposal includes the appropriation of money. Second, it involves the Affordable Care Act. Third, President Obama proposed it. You'd have a better chance of finding a snowball fight in August.
This is going to take a fight - but it's a fight we've got to have if we're serious about ending health disparities in poor communities and making our health care system work for everyone.
It's time to rally support for this critical expansion of health care access, and let members of Congress know they need to find a way to get it done... or they'll have a lot of explaining to do to their constituents who finally get health coverage this year only to find they still can't get health care.
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